Provider First Line Business Practice Location Address:
200 E MAPLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66725-1804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-429-1999
Provider Business Practice Location Address Fax Number:
620-429-1278
Provider Enumeration Date:
07/22/2006